Provider Demographics
NPI:1508975194
Name:PADILLA, RAFAEL E (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:E
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-444-5172
Practice Address - Fax:401-444-5090
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10465207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI407129OtherBLUE CHIP
MA010465OtherTUFTS HEALTHPLAN
RIRP33653Medicaid
MA3096599OtherMEDICAID
RI2378OtherNEIGHBORHOOD HEALTH PLANS
RIF33607Medicare UPIN